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08/13/14
Nutrition and Hydration
for the Elderly
In-service Training Guide
Nutrition
The process by which
the body takes in
and uses food
to maintain health.
Components of a Healthy Diet
Six Basic Nutrients:
1) Protein - Essential for tissue growth and repair
2) Carbohydrate s- Supply fuel for body’s energy needs
(complex and simple)
3) Fats - Helps store energy, protects organs,
vitamin absorption
4) Vitamins - Needed for body and organ function.
(water soluble and fat soluble)
5) Minerals - Needed for cell function and energy
6) Water - Essential for all body functions
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Identifying Nutritional Problems
 Aging increases the risk of malnutrition
 Body functions slow as part of the aging process
 Loss of vision
 Weakened sense of smell and taste
 Decreased saliva production
 Dentures, tooth loss, or poor dental health
 Slower digestion
 Loss of independence / Physical limitations
 Chronic disease processes
Malnutrition
Can result in:
 Confusion and memory loss
 Weakness and increased risk for falls
 Inability to fight off or recover from illness
 Loss of muscle mass
 Skin issues
 Impairment of organ function
 Anemia and other abnormal lab values
 Death
Hydration
The process by which
the correct water ratio
is maintained within the body
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Identifying Hydration Problems
 Fever
 Vomiting/Diarrhea
 Excessive exposure to heat
 Medications
 Decreased sense of thirst
 Decreased ability to communicate fluid needs
 Self-imposed restriction
 Chronic Illness
Dehydration
Can result in:
 Confusion and disorientation
 Abnormal vital signs
 Urinary tract infections
 Pressure Ulcers
 Pneumonia
 Death
Symptoms of Dehydration
 Dry sticky mouth / mucous membranes
 Increased thirst
 Decreased urine output
 Dry skin / poor skin turgor
 Headache
 Fatigue
 Constipation
 Dizziness / lightheadedness
 Increased confusion / agitation
 Abnormal Vital Signs
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Artificial Nutrition and Hydration
 Refers to a chemically balanced mixture of
nutrients and fluids used to help sustain life
 Usually administered by a surgically placed
Gastrostomy tube (G-tube)
 Used when a resident is unable to take food
and fluids by mouth or when the intake is
inadequate to support life
 Nutritional needs are calculated by a dietician
Caring for Residents with
“Feeding Tubes”
 HOB elevated at all times / during feedings
 Keep skin around tubing clean and dry
 Ensure good turning and positioning routine
 Use pressure relieving devices
 Provide oral / mouth care
 Licensed personnel should ensure correct
tubing placement and perform flushes per
facility policy
Important!!
 CNAs CANNOT administer tube feedings or
water flushes
 CNAs CANNOT disconnect or reconnect
feeding tubes
 CNAs CANNOT turn a feeding pump on or off
Questions about any of these?
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Unintended Weight Loss
 Serious problem for the elderly
 Can be an indication of serious medical
condition
 Can lead to increased weakness and frequent
falls
 Can lead to skin breakdown
 Residents with certain diseases are at higher
risk
 Accurate weights are essential
Tips for Weighing Residents
 Have the same person consistently weigh the resident
 Weigh the resident at the same time of day and with the
same type of clothing
 Use the same scale each time the resident is weighed
 Calibrate the weight of the scales (verify the accuracy of
the scale), determine the weight of the wheelchair
 Reweigh the resident if the weight is out of line with the
previous weight
Recognizing and
Reporting Changes
 Changes in appetite
 Increased difficulty with meals,
needs more assistance
 Difficulty swallowing (Dysphagia)
 Increased confusion or behavior problems
 Physical complaints
 Decreased urine output
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Dysphagia
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Frequent coughing when being fed, especially liquids
Repeated attempts to swallow or increased effort to swallow
Gurgling or wet sounds or loss of voice
Drooling or dribbling
Continuous throat clearing
Unswallowed food or pocketing
Spitting out pieces of food
Slower eating or avoidance
A feeling of fullness in the throat
Watering eyes
Fluid that comes up into the nose
Identifying Residents
Requiring Assistance
 Cognitive impairment / Dementia
 Visual impairments
 Poor motor control of upper extremities /
physical limitations
 Decreased endurance or strength
 Decreased motivation
 Impaired swallowing function
 High risk for aspiration
Levels of Assistance
 Independent - Usually do not require any assistance to
eat or drink. All residents should be encouraged to be as
independent as possible.
 Set Up Assistance - May need helping opening packages
and seasoning food; however, can feed themselves.
Check in frequently to see if they need further assistance
 Partial Assistance - Will need set up assistance plus
possible verbal, visual, or physical cueing.
 Total Assistance - Usually unable to feed themselves due
to physical or mental limitations
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Adaptive Equipment
Devices that are used to assist a resident in
feeding themselves. Examples include:
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Non-skid mats
Weighted, Angled, or Rocker utensils
Built up handles
Scoop plates and bowls
Lidded cup
Cup holder
Cut out cup
Special Diets
 NPO - Nothing by mouth
 Consistent Carbohydrates / No Concentrated
Sweets
 Low Sodium
 Fluid Restricted
 Low Fat / Low Cholesterol
 Renal Diet
 Liquid Diets - Clear and Full
 Altered Texture - Mechanical soft, Puree
Thickened Liquids
 Ordered for residents with known swallowing
problems.
 Three basic consistencies:
• Nectar Thick
• Honey Thick
• Pudding Thick
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Dietary Supplements
 Liquids or foods ordered for the resident to
improve their nutritional status
 Liquid supplements like Ensure or a simple
snack can be served in addition to meals to
maintain nutritional status
 Main meals are the first priority
 Should be served in a timely manner and
encouraged to be consumed
Diet / Tray Cards
 Correct Diet
 Food and fluid consistencies
 Allergies
 Adaptive Devices
 Food Preferences
 Always check the diet card against the tray
before serving
Improving Good Nutrition
and Hydration
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Be aware and report changes
Be informed of special diets
Encourage adequate fluid intake
Assist residents that require help to ensure adequate food and fluid
consumption
Allow enough time for residents to complete the meal - never rush
Honor food likes and dislikes
Season food
Use assistive devices
Make eating a sociable event - encourage conversation
Keep noise and distractions to a minimum
Encourage independence
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Remember…..
Your residents are relying on YOU, and your
team, to provide their care
“Your team should be better
because you are on it”—Dr. Bryan Williams
Thank you for the care that
you provide to our residents!
Arkansas Innovative Performance Program (AIPP)
1020 W 4th Street, Suite 430 • Little Rock, AR 72201
877-375-5700 • (Fax) 501-375-5926
[email protected] • aipp.afmc.org  arkansasculturechange.com
nhqualitycampaign.org
THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO
NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT.
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